Oklahoma

Oklahoma is primarily a rural state with a population distinguished by multiple ethnicities, numerous tribal affiliations, and rich cultural traditions.

Although American Indians comprise just 7 percent of Oklahoma’s population, the state includes 38 federally recognized tribal nations, who share a proud and painful history that to this day exerts an influence on their relationship with the state and federal government. Some tribes handle their own health care and other service needs, while others receive direct services from the federal government’s Indian Health Service (IHS). Although tribes set their own laws, they have worked with federal and state governments on initiatives to improve community health.

Oil production has figured prominently in Oklahoma’s economic fortunes—and distress—since 1897, when oil was discovered in the state’s northeast corner. The state was one of the nation’s leaders in oil production until the mid-1940s, after which drilling slumped, rebounded, boomed again. Growth continued between 2002 and 2012, but in 2014, the bottom dropped from oil prices yet again. Since June 2014, plummeting oil prices have cost the state more than 12,500 jobs, created significant budget shortfalls, and limited funding for the Oklahoma State Department of Health (OSDH). Fiscal constraints on OSDH have far-reaching implications for the health and well-being of all Oklahoma residents.

Overview

Population

Race/Ethnicity

Population Living in Poverty

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Community Context and Challenges

Oklahoma ranks 43rd of 50 states for overall resident health; poor health outcomes are driven by high rates of smoking, physical inactivity, obesity, diabetes, and limited access to health services.

American Indians experience higher rates of diabetes and have significantly higher death rates from unintentional injury, compared to white, black, Hispanic, and Asian populations.

Suicide is the second-leading cause of death among Oklahoma’s American Indian/Alaska Native population ages 10 to 34.

18% of Oklahoma’s population lacks insurance, compared with the national rate of 14%.

64 of Oklahoma’s 77 counties are primary care shortage areas, which means that 59% of Oklahoma residents may have a hard time accessing a primary care doctor.

Community Actions: A First Look

Through planning and outreach to cross-sector partners, OSDH has laid the groundwork to address barriers to health care and promote health and well-being across urban centers, rural communities, and tribal nations.

Early signs of progress from specific collaborative efforts are encouraging, such as transforming the public health infrastructure and reducing high rates of tobacco use and teen pregnancy. But the state’s significant fiscal distress has thrown OSDH’s multipronged efforts into question. In light of the chronic disease burden affecting the state’s American Indian and other minority populations, how the state will be able to adequately fund OSDH’s outreach and educational efforts remains an important, but unanswered, question.

These baseline reports, created in 2016, reflect our initial observations on select community programs and initiatives to gaugae ongoing, as well as newer, efforts to improve community health. Future reports will provide more in-depth insights and analysis into this community's activities.

1

Making Health a Shared Value

Cultural competence and diversity

2

Fostering Cross-Sector Collaboration

Turning Point

3

Creating Healthier, More Equitable Communities

Community Health Improvement Plan

4

Strengthening Integration of Health Services and Systems

Telemedicine

Making Health a Shared Value

Cultural competence and diversity

As part of its mission, the Office of Tribal Liaison encourages cultural competence and diversity among the OSDH workforce and supports the translation of public health findings specific to American Indian populations into practice. Its impact was demonstrated through a recent collaboration between tribal health leaders and OSDH regional health directors to address low childhood and adult vaccination rates in the state’s Southeast region. Tribes volunteered to pay for the vaccines, which OSDH administered across tribal districts.

Fostering Cross-Sector Collaboration

Turning Point

Turning Point, a Robert Wood Johnson Foundation national program designed to “transform and strengthen the public health system in the United States to make the system more effective, more community-based and more collaborative," has helped initiate a new mindset within the Oklahoma public health community by fostering collaboration between state public health systems and local partners, such as businesses, faith organizations, and community organizations. Turning Point’s influence has sustained beyond its initial Foundation funding, and the resulting partnerships have influenced how state and local relationships are formed and sustained. Sixty-six partnerships forged under Oklahoma Turning Point continued to operate in 2014, representing 62 of Oklahoma’s 77 counties.

Creating Healthier, More Equitable Communities

Community Health Improvement Plan

More than 65 stakeholders were brought together to develop a Community Health Improvement Plan for Tulsa County, which was completed in early 2017. The plan focuses on two main priority areas: access, including transportation, housing, health care, and healthy food; and education, which takes into account nutrition, educational attainment, and health literacy. Pathways to Health also awarded six seed grants to community health partners to build a community garden; offer an online, evidence-based health and fitness program at workplaces; and expand a children’s garden to include a library and a miniature farm.

Strengthening Integration of Health Services and Systems

Telemedicine

The Center for Rural Health, established within Oklahoma State University’s (OSU) Center for Health Sciences and its College of Osteopathic Medicine, seeks improvements in rural health care access through student education, residency training, research, and advocacy. OSU’s Center for Health Sciences’ TeleHealth program has one of the state’s largest telemedicine networks, connecting health providers to patients in communities that lack accessible hospital and physician care. All OSU medical students receive training in telemedicine, and OSU’s College of Osteopathic Medicine was the first medical school in the nation to require telemedicine training of all its graduates.

Going Forward: Questions for Consideration

Despite funding challenges and its largely rural environment, Oklahoma has made strides to prioritize key health goals and convene and develop strategic partnerships and collaborations to achieve them. Turning Point provided an infrastructure for collaboration that continues to this day and facilitates initiatives implemented locally throughout the state. Through its Office of Tribal Liaison, OSDH has developed an infrastructure to promote outreach and collaboration on public health initiatives with the state’s 38 tribal nations. Additional surveillance, data and information gathering, and analysis is needed to determine whether Oklahoma’s recent initiatives are reducing chronic disease and improving overall health—especially among minority residents in low-income metropolitan areas and tribal communities. Finally, given the recent funding cuts to key public health programs, questions remain about the sustainability of efforts in turbulent economic times and whether the infrastructure developed to improve health and well-being is at risk.

The following questions will be addressed in future reports:

How are cross-sectoral partners, including those initiated under the Turning Point program, working together to plan and implement statewide infrastructure and vision? To what extent are statewide planners examining data to drive their decision-making?

How are statewide cross-sectoral partnerships working within Oklahoma’s tribal nations? Have they been effective in promoting collaboration and addressing health challenges facing the American Indian population?

To what extent can the impact of American Indian–led initiatives to address teen suicide and childhood obesity be measured?

To what extent will Oklahoma’s extensive planning efforts address socioeconomic disparities, such as poverty and lack of insurance, among Hispanics and blacks?

To what extent have Oklahoma statewide and regional initiatives been effective in addressing teen pregnancy and maternal-child health?

How will Oklahoma develop and execute initiatives to improve state health outcomes once planning and priority-setting are finalized?

To what extent have efforts to address the state’s high rates of childhood obesity been successful? Are new strategies available to help Oklahoma’s fight against childhood obesity?

What effect has the remote nature of Oklahoma’s vast rural setting had on access to care for low-income, uninsured residents, especially those who live in sparsely populated areas?

What impact has funding instability had on the health infrastructure in Oklahoma and how has that impacted key factors such as partnerships, collaboration, and service delivery?

How are collaborative relationships and initiatives, such as the Oklahoma Turning Point Council and Certified Healthy Oklahoma, sustained in the face of unpredictable funding?